Monday, December 11, 2017

Concussions in Sports

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by Margaret van Blerk, M.D.
November 2011

With so many of our children playing sports, we are seeing an increase in the number of sports-related injuries. Some of the most common injuries that we see are concussions. We have heard a lot about concussions recently with an increased awareness of the serious nature of these injuries and the long term consequences. It is estimated that about 136,000 concussions occur in high school sports every year. This may be a low estimate as many concussions are not reported. The majority of concussions are seen in football but there is also a significant number in hockey, soccer, basketball and wrestling. Most are seen in high school athletes, however with younger children becoming more involved in sports, these injuries are now being seen more commonly in younger children ages 8-13. These injuries may be more serious in younger children due to their developing brains.

What is a Concussion?

A concussion is defined as a traumatic brain injury. It may be defined as a head injury with a temporary loss of brain function. It may have effects on someone’s cognitive ability, their emotions, and it may cause a number of physical complaints. Most people with a concussion have some symptoms for about 24 hours and about 15% are symptomatic for more than one week. Usually by three weeks all of the symptoms are gone. However, it may take weeks or months to recover completely. There is a potential for serious or catastrophic outcomes if an affected player returns to play too soon. There is also a potential for cumulative effects with repeated concussions.

Common Signs and Symptoms of Concussions

  • Physical- May complain of headaches, dizziness, poor coordination or balance, sensitivity to light or sound, nausea or vomiting, changes in vision, numbness or tingling.
  • Cognitive or mental signs- Confusion, disorientation, poor concentration or easily distracted, post traumatic amnesia, feels “foggy”, slow to respond, slurred or incoherent speech.
  • Emotional- Inappropriate emotions, sadness, nervousness or anxiousness, restlessness, irritability or lethargy.
  • Sleep Issues- Difficulty falling asleep, fatigue, sleeping more or less than normal.

Medical Assessment of Concussions

  • It is important that anyone who is suspected of having a concussion be evaluated by a physician and given medical clearance before they are allowed to return to play.
  • Diagnosis is based mainly on history and physical, duration of unconsciousness, post traumatic amnesia, and neuropsychological testing.
  • Based on the history and physical exam, a CT or MRI may be indicated, but the results of CT or MRI are usually normal with a concussion.
  • Neuropsychological testing may be useful in evaluating a patient with a concussion. Some schools are starting to do a baseline assessment of athletes before the season starts so that they can see if they have any changes after a head injury. This is just one tool in the assessment of a concussion. Serial testing may be useful in determining when the athlete is ready to return to play.

Treatment of a Concussion and Return to Play

There is no medication used to treat concussions. It is important that the athlete is allowed to rest and not return to play until they are asymptomatic both at play and at rest. They should avoid loud noises as this may exacerbate their symptoms. They should also avoid physical and cognitive exertion such as schoolwork, video games, using a computer or watching TV as these may worsen the symptoms. They should not return to play if they are having any symptoms or if they are having trouble focusing in school.

Retirement from a sport should be considered if an athlete has suffered from multiple concussions or if they have suffered post-concussive symptoms for more than three weeks.

Prevention

It is not likely that we will prevent all concussions but we can reduce the risk by following the rules of the game and wearing proper safety equipment. It is important that the athletes and coaches are educated about the dangers of concussions. They must be made aware that continuing to play after a concussion can have life-long repercussions which we are just beginning to study.

References:

Halstead ME, Walter,KD; Council on Sports Medicine and Fitness. Sports-Related Concussions in Children and Adolescents. Pediatrics.2010. Sep; 126(3):596-615.

The contents of this web site are provided as an informational tool. This is not intended to replace medical advice or care administered by a healthcare professional. Common sense should always be used when referencing this site. If, at any time, you feel your child is experiencing a medical emergency, call 911 immediately.

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